The Journal of the Association of Physicians of India最新文献

Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and pneumonia are challenging lower respiratory tract infections (LRTIs) commonly encountered in clinical practice. The oral extended-spectrum cephalosporin cefpodoxime proxetil is highly active against the bacterial pathogens commonly associated with LRTIs.

Aim: To assess the role of cefpodoxime in the management of infections in Indian patients with AECOPD and LRTIs in a real-world setting, based on expert opinions.

Methodology: The expert consensus meeting was convened according to an a priori protocol. Physicians were invited to participate in the discussion to frame opinion statements based on their clinical experience. A structured questionnaire was prepared regarding the role of cefpodoxime in the management of infections in patients with AECOPD and LRTIs.

Results: Streptococcus pneumoniae was the most common pathogen causing infections in patients with chronic bronchitis and pneumonia. Good penetration of cefpodoxime into lung tissues, high concentrations in lung tissues, and rapid resolution of symptoms make cefpodoxime the first-choice drug for treating LRTIs. Cefpodoxime is a step-down therapy of choice when switching hospitalized patients with LRTIs from parenteral antibiotics to oral antibiotics. Cefpodoxime is safe in patients with comorbid diseases and in elderly patients on polypharmacy.

Conclusion: Cefpodoxime is the preferred first-line empiric antibiotic of choice for the treatment of community-acquired LRTIs in the real-world setting in India. Cefpodoxime has been preferred by 99% of expert chest physicians to treat infections in patients with chronic obstructive pulmonary disease (COPD), considering its broad spectrum of activity. Ninety-seven percent of experts reported that cefpodoxime, as a step-down therapy, gives satisfactory patient recovery and prevents recurrent infections.

A total number of 20 cases of prosthetic valve thrombosis (PVT) involving left-sided bileaflet St Jude's prosthesis (16), Medtronic Hall (3), and pulmonary prosthesis (1) are reported. Streptokinase (STK) fibrinolysis provided excellent results in 66.6% of cases with thrombosed St Jude's mitral prosthesis and remains the preferred option for this subset. Percutaneous manipulation of the mitral disk proved a useful adjuvant. Reteplase produced gratifying results in pulmonary mechanical prosthesis. However, thrombosed aortic prosthesis responded unfavorably to fibrinolysis. About six patients who failed to respond to thrombolysis had excellent results with valve replacement surgery. Two patients (10%) succumbed due to extremely high-risk clinical characteristics.

Background: Brain tumors are among the most aggressive malignancies requiring multimodal therapy, including chemotherapy. In India, where healthcare is predominantly financed out of pocket, the cost of anticancer medications poses a significant barrier to treatment adherence. A wide disparity exists between the costliest branded drugs and their lower-cost alternatives, raising concerns about affordability and equity in care. This study aimed to perform a cost-minimization analysis (CMA) to quantify cost differences (CDs) among the most expensive, least expensive, and generic chemotherapy drugs used for brain tumor treatment.

Materials and methods: This descriptive pharmacoeconomic study compared the costs of eight chemotherapy agents-temozolomide, procarbazine, lomustine, carmustine, vincristine, bevacizumab, irinotecan, and carboplatin. Drug prices were sourced from the Current Index of Medical Stores (CIMS) and government databases. Dosages were standardized based on average Indian adult body surface area (BSA). Cost metrics included CD, cost ratio (CR), and percentage cost variation (PCV). Regimen-wise costs were calculated per cycle and overall.

Results: Significant cost variation was observed across all formulations. Temozolomide 250 mg showed the highest fold difference (8.94×), while bevacizumab displayed a 3.3× difference. Adjuvant temozolomide over 12 months ranged from ₹32,220 (generic) to ₹3,90,000 (costliest brand). PCV values ranged from 27.7% (carboplatin) to over 700% (temozolomide). Most CDs were statistically significant (p < 0.05).

Conclusion: This study highlights substantial pricing disparities in chemotherapy for brain tumors in India. Cost-effective alternatives can significantly reduce treatment-related financial toxicity. Incorporating pharmacoeconomic evidence into prescribing decisions is essential to improve equitable access to neuro-oncology care.

Asthma and chronic obstructive pulmonary disease (COPD) are obstructive airway diseases (OADs) that contribute significantly to the burden on healthcare systems in low- and middle-income countries like India.^1,2 Inhaler therapy (primarily involving pressurized metered-dose inhalers and dry powder inhalers) remains the cornerstone of maintenance therapy; however, not all patients can use them effectively.³ Home maintenance nebulization (HMN) has been increasingly used as an alternative in appropriately identified patients, particularly those with advanced disease, physical or cognitive limitations, or suboptimal inspiratory flows. This expert consensus is an update from the 2017 recommendations, which provide evidence-informed recommendations on the use of HMN in OADs.⁴ By incorporating recent research findings and clinical expertise, the updated consensus addresses current gaps in knowledge, optimizes therapeutic protocols, and supports healthcare providers in delivering high-quality, patient-centered care. It is aimed at aiding clinicians involved in the management of OADs, including asthma and COPD, and evaluating the suitability of nebulization therapy as long-term maintenance treatment in home care settings.

Background: Rural areas continue to grapple with a lack of access to healthcare despite the development of technologies like telehealth, artificial intelligence (AI), virtual and mixed reality, nanotechnology, and robotics. However, there are encouraging ways to get beyond these obstacles with the advent of AI tools. To close the healthcare gap in rural India, the research explores the viability and effectiveness of implementing AI solutions.

Methods: A scoping review was used in the study to help define its objectives and parameters as well as to examine the efficacy and potential of AI tools in bridging the gap in rural healthcare. The information was taken from a number of databases such as PubMed, ScienceDirect, and Google Scholar that contained English-language publications from January 2020 to December 2023. The data were recorded and screened with the help of electronic data processing software called "Rayyan," and the results were displayed thematically.

Findings: The study shows how AI-driven solutions could be used to address and overcome healthcare access gaps, highlighting the potential for implementing AI technologies in rural healthcare settings. In order to successfully incorporate AI tools, the report also identifies barriers to their acceptance in rural healthcare and suggests joint efforts by healthcare providers, policymakers, and technology developers. In order to adopt AI in rural areas, this study requires supporting investments in capacity-building programs, digital infrastructure, and supportive legislative frameworks.

Conclusion: The paper emphasizes how AI is transforming healthcare in rural India and closing the gap in access. Healthcare professionals and legislators can overcome obstacles, provide local healthcare staff with better infrastructure, and enhance health outcomes for rural regions by utilizing AI technologies. The conclusions and suggestions help to advance the body of knowledge on using AI to provide appropriate healthcare, which will direct similar projects in the future.

Background/introduction: The Indian subcontinent faces a substantial healthcare challenge with allergic bronchopulmonary aspergillosis (ABPA). While numerous investigations have explored ABPA's occurrence in the general asthmatic population, there remains a significant knowledge gap regarding its specific prevalence among individuals with severe asthma. Current Indian research demonstrates considerable variation in reported ABPA prevalence rates among severe asthmatics, highlighting the need for more comprehensive investigation.

Objective: This research initiative aimed to determine the precise prevalence of ABPA among severe asthma patients seeking treatment at a tertiary healthcare institution in northwestern India, with the goal of enhancing our understanding of this complex condition's burden in this specific patient population.

Methodology: We conducted a comprehensive cross-sectional investigation spanning August 2022 through July 2023. The study encompassed 247 patients diagnosed with severe asthma. Each participant underwent thorough clinical evaluation and provided blood samples for comprehensive analysis, including absolute eosinophil count measurement, total IgE quantification, and specific testing for Aspergillus fumigatus-related IgE antibodies. When clinically indicated, additional diagnostic procedures included Aspergillus-specific IgG testing and detailed chest imaging through X-ray or high-resolution computed tomography (HRCT).

Results: Our investigation revealed that 63.2% (156 out of 247) of severe asthma patients met the diagnostic criteria for ABPA. The affected population showed a mean age of 41.6 years, with a relatively balanced gender distribution (80 females, 76 males). Among those diagnosed with ABPA, we observed a notably higher prevalence of ABPA-B (92.3%, 144 patients) compared to ABPA-S (7.7%, 12 patients).

Conclusion: This research represents one of the most extensive investigations to date documenting such a high ABPA prevalence (63.2%) among severe asthma patients in northern India. These findings underscore the critical need for expanded research initiatives to investigate the underlying factors contributing to such elevated ABPA rates in this geographical region, ultimately aiming to develop and implement effective preventive strategies at the community level.

Background: Sepsis is a leading cause of mortality globally, yet obtaining accurate population-level data remains challenging. According to a 2020 report, there were approximately 48.9 million cases of sepsis and 11 million sepsis-related fatalities worldwide, accounting for 20% of all deaths globally. This study aims to assess the diagnostic efficacy of patient evaluation in comparison with the Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II (APACHE II), and Simplified Acute Physiology Score (SAPS) indices, in a quaternary care hospital, and to analyze the impact of various clinical parameters and comorbidities on patient outcomes.

Materials and methods: The study was conducted at Hindu Mission Hospital in Chennai and used a retrospective design to analyze septicemia patients' data from June 2018 to January 2020. The database included clinical presentation, vital signs, comorbidities, laboratory values, and septicemia features. Specimens underwent smear microscopic analysis of the mycobacterial culture.

Results: The study found that elevated SOFA and APACHE II scores, comorbidities, prompt antibiotic administration, and infection characteristics significantly impact sepsis patient outcomes, emphasizing the importance of timely intervention and comprehensive scoring systems.

Conclusion: The study emphasizes the significance of a comprehensive approach to sepsis management, including early detection, prompt intervention, and managing comorbid conditions, and suggests future research should focus on accurate predictive models and personalized medicine approaches.

Background: Hypertension is a chronic condition that progressively worsens. Lifestyle modifications and antihypertensive medications are among the strategies recommended to manage it. Nonpharmacological interventions like deep relaxation, Aum Kara chanting, and tuning have been found to help lower blood pressure, enhance cardiovascular function, reduce stress, and promote mental tranquility. This study examines the effects of Aum Kara and the deep relaxation technique (DRT) on autonomic variability in individuals with primary hypertension.

Methods: From a pool of 200 individuals screened for hypertension at SDM Hospital in Dharmasthala, 60 participants aged 25-50 were selected according to the study's inclusion and exclusion criteria. The enrolled participants were assigned to one of two groups: group 1 (DRT) or group 2 (Aum Kara) based on randomization tables. Each group underwent a 20-minute session, after which their data were evaluated.

Results: Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) decreased immediately after the interventions in both groups. The Aum Kara group demonstrated a decrease in heart rate and the LF/HF ratio compared to the DRT group (p < 0.05). Specifically, in the Aum Kara group, LF decreased and HF increased, showing statistical significance in comparison to the DRT group. A significant difference was noted in all HRV components between the groups upon comparison.

Conclusion: In the comparison of the two therapies' effects, Aum Kara chanting demonstrated a more significant immediate beneficial impact on the sympathovagal system balance compared to DRT.

We present the case of a 45-year-old woman who survived a suicide attempt with partial hanging and presented with electrocardiographic (ECG) abnormalities that mimicked acute coronary syndrome (ACS). She exhibited ST-segment abnormalities and QT interval prolongation, all of which resolved within 1 month. This case highlights the importance of recognizing stress-induced cardiomyopathy, such as Takotsubo cardiomyopathy, which can present with ECG changes similar to ACS, particularly in patients experiencing extreme emotional distress or suicide attempts.